Obama in Boston: Does Massachusetts prove Obamacare will work?

On Wednesday, the president will defend Obamacare at Faneuil Hall in Boston – the site where in 2006, then-Gov. Mitt Romney signed similar health-care reforms into law for Massachusetts.

President Obama, in a scramble to defend his health-care reforms, has a simple message: If you question whether the Affordable Care Act (ACA) will work, just look at Massachusetts.

Mr. Obama’s Wednesday afternoon visit to Faneuil Hall in Boston, the site where in 2006, then-Gov. Mitt Romney (R) signed similar health-care reforms into law for Massachusetts, is designed to help stem a stream of bad press about Obamacare’s rollout.

The ACA, like the Massachusetts law, seeks to expand the ranks of the insured by saying that people must enroll in a health-insurance plan or pay a penalty. Both laws offer subsidies to help people who have trouble affording insurance.

The Massachusetts law, sometimes called Romneycare, enjoys broad popularity in the Bay State. So far, Obamacare has been roiled by problems that include a malfunctioning website and widespread cancellations of existing policies that Obama promised “you can keep.”

So, what about the premise of Obama’s visit: Does Massachusetts prove that Obamacare will work?

A short answer is that some lessons from Massachusetts line up well with the hopes of Obamacare supporters, but at the same time, a state-level experience doesn't guarantee replication at the national level.

Massachusetts has seen a dramatic reduction in the percentage of residents who lack insurance coverage for medical care, good competition among insurance firms to offer that coverage, and no big spike in costs, says Jonathan Gruber, a Massachusetts Institute of Technology expert on health policy who helped design both Obamacare and the earlier law in his home state.

“We need to be patient,” Mr. Gruber told reporters in a briefing organized by the White House ahead of Obama’s Wednesday trip to Boston. Residents of Massachusetts didn’t sign up in droves in the first month, and Obamacare's success “needs to be measured in months and years, not days and weeks.”

He pushed back against critics who have framed the ACA as a government takeover of health care. “The notion that this is ... antithetical to private insurance is simply wrong,” he said, noting that employer-based coverage of Massachusetts workers increased after the state enacted its law.

It’s true that the Obama team still has some time to recover, when it comes to the early problems with enrollment on HealthCare.gov.

But the Massachusetts law, The Boston Globe reports, rolled out with a website that worked relatively smoothly – in part because the software didn’t need to interact with so many insurance firms and states. Some 36 states are relying on HealthCare.gov for their Obamacare insurance marketplace.

That fact, in turn, hints at two potentially meaningful differences between the Massachusetts experience and Obamacare.

First, the Massachusetts reforms were crafted for a state – not an effort to make one law work for 50 diverse states.

During the 2012 election, Mr. Romney, as the GOP presidential nominee, opposed Obamacare partly on the argument that states should be able to address health-care policy individually. What worked well in Massachusetts might not be the thing for Kansas. Massachusetts started its experiment, for one thing, with a relatively high share of its residents already insured.

Second, the two laws contrast in the political climate that surrounds them. Where the Massachusetts reforms brought diverse interests together, including a Republican governor and a Democratic legislature, Obamacare was a Democratic initiative, and it has fueled sharp partisan controversy from its inception to the present.

The national political climate isn’t a trivial part of the equation. Some Republican governors chose to have their states opt out of the ACA’s expansion of Medicaid – partially thwarting the act’s goal of extending insurance to many near-poor Americans through that program.

Similarly, the issues with the HealthCare.gov website stem partly from the fact that many conservative states opted not to set up their own insurance marketplaces under Obamacare. Instead, the federal website is now the portal to marketplaces for more than half the states.

A sign of the political challenge: Obamacare has never scored very well in public opinion, even though Americans generally support many of its features – such as the idea that people shouldn’t be denied coverage because of preexisting medical conditions.

That means that the federal law doesn’t enjoy much cushion of public goodwill as it heads into implementation.

The Massachusetts rollout, by contrast, was marked by cooperation between both political parties and among outside groups such as employers and nonprofit foundations to help the reforms succeed. Most state residents have consistently voiced support for the law in polls.

Does this mean Obamacare will end up failing to match the story that residents of Massachusetts see as a success? Not necessarily. But it signals that Obama’s road ahead is tougher than the path that governors in the Bay State have faced since 2006.

Even in the White House briefing for the news media, one idea that emerged from health-care experts was that states that embrace Obamacare might set the stage by succeeding first. If implementation goes well in politically blue states, residents of conservative red states may put pressure on their politicians to join in the reforms.